Orthostatic Intolerance and Autonomic Dysfunction in Youth With Persistent Postconcussion Symptoms: A Head-Upright Tilt Table Study.

OBJECTIVE: To explore head-upright tilt table (HUT) signs of autonomic dysfunction in a cohort of youth with persistent postconcussion symptoms (PCSs) that include light-headedness and to correlate repeat tilt table results with symptom improvements for those patients found to have postural tachycardia syndrome (POTS) on initial testing. DESIGN: Prospective cohort design. SETTING: Nationwide Children's Hospital, Neurology Clinic. PARTICIPANTS: Thirty-four patients (13-18 years of age) with persistent PCSs. MAIN OUTCOME MEASURES: All patients underwent at least 1 tilt table test. The PCS Interview (PCS-I) and patient ratings of light-headedness and vertigo were used to measure symptom burden. Patients found to have POTS were asked to repeat tilt table testing when PCSs improved or 3 to 6 months after the initial test if symptoms persisted. RESULTS: Twenty-four of the 34 (70.6%) patients had abnormal tilt table results with patients categorized as normal (n = 10), isolated syncope (n = 10), and POTS (n = 14). Patients with POTS had higher PCS-I scores than normal patients (P < 0.001) and higher ratings of light-headedness than both normal patients (P = 0.015) and syncope patients (P = 0.04). Twelve POTS patients underwent repeat tilt table testing, and 9 of 12 (75%) no longer met POTS diagnostic criteria. All patients with resolution of POTS had corresponding improvements in PCSs, including light-headedness and vertigo. CONCLUSIONS: Our study demonstrates a high rate of tilt table abnormalities among youth with persistent PCSs. Several patients with POTS had normalization of tilt table testing when PCSs improved. These findings warrant further research of autonomic dysfunction related to concussion. CLINICAL RELEVANCE: Our study is the first to prospectively characterize autonomic dysfunction in patients with persistent PCSs using HUT testing and to show that the tilt test abnormalities normalize in some patients as PCSs improve.

Low proportion of high school senior athletes receiving recommended immunizations.

BACKGROUND: The preparticipation physical evaluation (PPE) often serves as the only preventive health care visit for athletes, but immunization status is not uniformly addressed in such visits. Thus, athletes may not be receiving recommended immunizations. Our aim was to determine the proportion of high school senior athletes who received all recommended immunizations. HYPOTHESIS: Our hypothesis was that females would be less likely than males to receive all recommended immunizations given suboptimal human papillomavirus (HPV) vaccine uptake. METHODS: We conducted a cross-sectional survey evaluation of the immunization status of high school senior athletes in Davidson County, TN. The primary composite outcome was receipt of recommended immunizations for tetanus, meningococcal, and seasonal influenza. For females, the primary outcome also included completion of the HPV series. RESULTS: A total of 162 participants, 104 males and 58 females, were included. More males than females received all recommended immunizations (15.4% vs 3.5%; P = 0.02). When HPV immunization was excluded from the composite outcome, there was no difference in the proportion of males and females who received all recommended immunizations (15.4% vs 15.5%; P = 0.98). The odds of receiving all recommended immunizations was 0.14 (95% CI, 0.03-0.72) for females compared with males when adjusted for covariates. Athletes seen at retail-based clinics for their PPE were less likely to receive all recommended immunizations compared with athletes seen in primary care (OR, 0.13; 95% CI, 0.02-0.69). CONCLUSIONS: Only 1 in 6 high school senior athletes received the recommended tetanus, meningococcal, and influenza immunizations. A lower proportion of females, only 1 in 28, received all recommended immunizations due to the HPV series. Policy changes requiring a review of immunizations at the PPE would benefit many high school athletes.

Enduring pictures in our heads: the continuance of authoritarianism and racial stereotyping.

This study highlights the importance of examining the influence of personality measures, specifically authoritarianism, on negative racial stereotyping, even in an era of alleged color blindness. The authors examine the relationship of various demographic variables and authoritarianism with negative racial stereotyping in a sample of White urban respondents. Current literature suggests that age, sex, marital status, religious identification, religious service attendance, education level, income, political affiliation, level of authoritarianism, and the demographic composition in an individual's local population all affect racial stereotyping. The evidence presented, using path analysis, suggests that some demographic characteristics influence the level of negative racial stereotyping. While the effects of most included demographic characteristics were statistically significant, others, which continually resurface in the literature, remained insignificant (such as the demographic composition of the respondent's area). The results of this study challenge the loss of traditional prejudice with color blindness and point to the importance of authoritarianism as a mediating factor in negative racial stereotyping. The authors conclude the greatest indicators of negative racial stereotyping included in this study are authoritarianism, education, and income, while many other demographics - such as marital status, religious identification and attendance, and political affiliation - have indirect influences through authoritarianism.